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  • Last Resort: Psychosurgery and the Limits of Medicine
  • George B. Murray
Last Resort: Psychosurgery and the Limits of Medicine. By Jack D. Pressman. (New York, Cambridge University Press, 1998) 555 pp. $49.95.

One could say, with Pressman’s aid, that the era of psychosurgery ended with the introduction of neuroleptic medication, the first of which was chlorpromazine in 1954. However, less well known, even by psychiatrists today, is that forms of psychosurgery—for example, cingulotomy, subcaudate tractotomy, and others—are still in legitimate use.

What we learned from the “psychosurgery era” (1936–1954) was that psychosurgery never was an effective treatment for schizophrenia. What we now know, however, is that cingulotomy, for example, can be helpful in severe depressions, obsessive-compulsive disorder, and chronic pain. Moreover, cingulotomy is still a “last resort” in such psychiatric disorders.

Though Pressman (who died in his 30s a few days after he sent his manuscript to the publisher) is an effective writer, his introduction seems to indicate that he had no idea that psychosurgery was being done today with good results. His first chapter, “Psychiatry’s Renaissance,” however, is an excellent overview of the status of the American school just prior to the “psychosurgery era.”

He gives us the complicated story of Dr. Egas Muniz of Portugal, a Nobel Prize winner and the first practitioner of psychosurgery in humans. The importation of lobotomy from Portugal to the United [End Page 489] States was effected mainly by Walter Freeman, the neurologist, and Dr. James Watts, the neurosurgeon. John Fulton’s involvement in the psychosurgery scene is well explored, as are the theoretical views of various psychiatrists at this time.

Pressman’s personal bias shines through this otherwise fine work. His typical liberal academic negative attitude regarding electroconvulsive therapy and psychosurgery, for example, is much easier to maintain if one does not have to treat and manage severe psychiatric patients. All in all, however, his is a well-written, thorough understanding of psychosurgery and the surrounding feelings, pro and con, at the height of its popularity.

George B. Murray
Massachusetts General Hospital
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